'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GP indemnity fees spiral out of control with 26% rise last year

Exclusive ‘Out-of-control’ GP indemnity costs have increased by more than a quarter in a year, show the results of a Pulse survey.

Indemnity fees rose by an average of 25.5% in the past 12 months leading up to November last year, according to an analysis of responses from more than 900 UK GPs.

But the increase could be even higher, as a large number of GPs said their fees had decreased because they had had to reduce the number of shifts they worked.

More than one in 10 respondents said their fees had more than doubled, and more than a quarter saw hikes in excess of 40% in the past year.

Medical defence organisations (MDOs) said that the figures were not representative, and they were seeing rises of around 10%.

However, these figures currently represent the best estimate so far of the rising burden of legal indemnity, as medical defence bodies have refused to provide comparable figures to Pulse.

Dr Zishan Syed, a GP partner in West Kent said his indemnity costs have increased by 60% in the past 12 months and said the MDOs needed to do more to challenge individuals who engage in campaigns of vexatious complaints against clinicians.

He added: ’Furthermore, the fact that they pick and choose what case to defend can leave a GP who has paid year after year of fees in the lurch with no defence.’

Dr Graham Scott, a GP locum in Warrington, said his fees had more than doubled, adding: ’‘I think that it is out of control and unfair. It needs serious regulation.’

Dr Ishwar Bhatia, a GP locum in Ipswich and East Suffolk, said: ’Compared to sessions worked, the amount has increased to double. A regular four sessions in surgery cost £5,100, and out of hours is more.’

Several GPs commented it was ’not worth increasing hours of work’ as the cost of indemnity was so high and they felt helpless to question fee rises.

A GP who did not want to be named said: ’There are no clear understandable rules for charges and because I don’t know how they work it out, I don’t have evidence for whether the charges are correct or not. I can’t complain as it is compulsory and we can’t work without indemnity.’

However, another GP who also wanted to remain anonymous, who saw a 20% increase in fees in the past year, said: ’When you’ve been through a complaint you realise how worthwhile it is, the support you get.’

The Medical Defence Union disputed the survey findings, claiming that average member subscription increases were lower, at around 10% a year. A spokesperson said: ’Long term, GP claims inflation has been running at over 10% year on year. Inevitably, this affects the subscriptions we need to collect to ensure our members’ peace of mind. Average subscription increases for our members reflect these trends rather than the figures your survey found.’

MDDUS also said most of its increases were smaller than 25%. A spokesperson said: ’MDDUS were able to limit subscription increases for the vast majority of our GP members to well below 20% this year. The numbers seeing increases at the level you quote were small – far smaller than the number of our Scottish members whose subscriptions were held stable.’

The survey was launched on 26 October 2015, collating responses using the SurveyMonkey tool. The 20 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. A total of 922 GPs answered this question.

Fees may be going up because NHS indemnity for hospital doctors has robbed defence unions of a profitable financial stream.They are paying a great deal for staff costs-So the GPs have to pay more to make up the difference.Just a thought?

I have just completed the I&R scheme. I was covered by the MDU. Now I'm salaried doing 8 sessions a week. The quote they gave me equated to £300 a week. That's just bread and butter surgeries. No Skype consultations, minor surgeries or OOH etc. Never had a complaint against me. Before my career break I'd used this companies cover for 11 years. Not any more.

A survey carried out by the Family Doctor Association on behalf of NHS England (who couldn't get the information out of the MDOs) showed similar findings - although when analysed by statisticians showed 14% true rise but some cases up to 30%. Also some doctors have had to stop practicing if they have fallen out of the mutuals' grasp and are on the commercial market. Worst I have heard of to date is £27000 per year PLUS a £250,000 excess on each claim (ie we don't want your business - and he has a good claims record)

Whilst I agree there needs to be more transparency about how the MDOs work out the fees they charge, I think we need to reserve the "regulating" for the fatcat ambulance-chasing lawyers and vexatious patients who make stupid claims on "no win no fee". Sometimes things do go wrong, and people have a genuine case, but they are in a minority if you ask me, and we all know one when we we see it...

If something seriously goes wrong an independent panel of sensible relevant professionals and patient representatives looks at the incident and harm done - and pays appropriate costs to care for the patient harmed.

Perhaps payments out will still be high for the most serious cases - ie baby needing permanent care, but all the legal costs will be stripped out, as well as the fishing expeditions and false claims.